Jacobs I, Davies A P, Bridges J, Stabile I, Fay T, Lower A, Grudzinskas J G, Oram D
Gynaecological Oncology Unit, Royal London Hospital.
BMJ. 1993 Apr 17;306(6884):1030-4. doi: 10.1136/bmj.306.6884.1030.
To assess the performance of the sequential combination of serum CA 125 measurement and ultrasonography in screening for ovarian cancer.
The serum CA 125 concentration of each subject was determined and those with a concentration > or = 30 U/ml were recalled for abdominal ultrasonography. If ultrasonography gave abnormal results surgical investigation was arranged. Volunteers were followed up by annual postal questionnaire.
General practice, occupational health departments, ovarian cancer screening clinic.
22,000 women volunteers who were postmenopausal and aged over 45 years.
Apparent sensitivity, specificity, positive predictive value, years of cancer detected.
41 women had a positive screening result and were investigated surgically. 11 had ovarian cancer (true positive result) and 30 had other disorders or no abnormality (false positive result). Of the 21,959 volunteers with a negative screening result, eight subsequently presented clinically with ovarian cancer (false negative result) and 21,951 had not developed ovarian cancer during follow up (apparent true negative result). The screening protocol achieved a specificity of 99.9%, a positive predictive value of 26.8%, and an apparent sensitivity of 78.6% and 57.9% at one year and two year follow up respectively. The estimated number of years of cancer detected by the prevalence screen was 1.4 years.
This screening protocol is highly specific for ovarian cancer and can detect a substantial proportion of cases at a preclinical stage. Further investigation is required to determine the effect of the screening protocol on the ratio of early to late stage disease detected and on mortality from ovarian cancer.
评估血清CA 125检测与超声检查序贯联合用于卵巢癌筛查的效果。
测定每位受试者的血清CA 125浓度，浓度≥30 U/ml者被召回进行腹部超声检查。若超声检查结果异常，则安排手术探查。通过每年邮寄问卷对志愿者进行随访。
全科医疗、职业健康部门、卵巢癌筛查诊所。
22000名绝经后且年龄超过45岁的女性志愿者。
表观灵敏度、特异性、阳性预测值、癌症检出年数。
41名女性筛查结果呈阳性并接受了手术探查。其中11人患有卵巢癌（真阳性结果），30人患有其他疾病或无异常（假阳性结果）。在21959名筛查结果为阴性的志愿者中，8人随后临床诊断为卵巢癌（假阴性结果），21951人在随访期间未患卵巢癌（表观真阴性结果）。该筛查方案的特异性为99.9%，阳性预测值为26.8%，在1年和2年随访时的表观灵敏度分别为78.6%和57.9%。患病率筛查估计检出癌症的年数为1.4年。
该筛查方案对卵巢癌具有高度特异性，能在临床前期检测出相当比例的病例。需要进一步研究以确定该筛查方案对早期和晚期疾病检出比例以及卵巢癌死亡率的影响。
